| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,101 |
1,559 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,713 |
1,320 |
$160K |
| D1120 |
Prophylaxis - child |
4,503 |
4,140 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
4,096 |
2,309 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,040 |
3,629 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,479 |
1,306 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
837 |
420 |
$115K |
| D1110 |
Prophylaxis - adult |
2,216 |
1,999 |
$96K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
531 |
193 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,784 |
3,445 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,632 |
3,332 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
827 |
492 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
680 |
293 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,224 |
2,043 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,946 |
1,793 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,273 |
1,155 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,026 |
2,503 |
$28K |
| D0330 |
Panoramic radiographic image |
862 |
717 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,164 |
1,653 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
593 |
530 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
599 |
505 |
$16K |
| D4346 |
|
121 |
116 |
$14K |
| D2332 |
|
109 |
67 |
$12K |
| D7111 |
|
86 |
65 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
195 |
184 |
$6K |
| D2330 |
|
64 |
42 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
25 |
$4K |
| D2331 |
|
22 |
13 |
$2K |
| D1354 |
|
46 |
15 |
$1K |
| D1999 |
|
902 |
680 |
$0.00 |